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Home My WebLink AboutMP15-101 19 VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Paul S.Rosenberg (914) 939-0668 Christopher J. Bradbury www.ryebrook.org TRUSTEES BUILDING& FIRE Susan R.Epstein INSPECTOR Stephanie J. Fischer Michael J. Izzo David M. Heiser Jason A. Klein CERTIFICATE OF COMPLIANCE December 3, 2021 John Welde Jr&Ashley Welde 15 Jennifer Lane Rye Brook,New York 10573 Re: 15 Jennifer Lane, Rye Brook,New York 10573 Parcel ID#: 135.58-1-19 This document certifies that the work done under Mechanical Permit #15-101 issued on 6/23/2015 for the installation of two 120 gallon above-ground propane tanks have been satisfactorily completed. Sincerely, Michael J. Izzo Building&Fire Inspector /tg 0 tim Q . moo BUILDING DEPARTMENT ❑BUILDING INSPECTOR 54"SISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑CODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573 (914) 939-0668 FAX (914) 939-5801 www.ryebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - -- - - - - ADDRESS: k 5 �\ t 1 L 1 L A ( ' DATE: PERMIT# ( � Q ' ISSUED: SECT: BLOCK: LOT: LOCATION: �. OCCUPANCY: °L ❑ VIOLATION NOTED THE WORK IS... Q ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS L.P.GAS FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL OTHER BR Ouk O y -c >>7. 1902 • BUILDING DEPARTMENT 0 BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑ VILLAGE ENGINEER 938 KING STREET RYE BROOK,NY 10573 D ASSISTANT BUILDING INSPECTOR (914) 939-0668 FAX(914) 939-5801 - - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - --- - - -- -- - ADDRESS: � �( � Q,� L; f` DATE: �Z' I' 1 PERMIT# IS SUED: 23 1 $Ecr: 3 BLOCK: LOT: LOCATION: �-z a � � � OCCUPANCY: I �� ❑ VIOLATION NOTED THE WORK IS... ACCEPTED ❑ REJECTED/REINSPECI'ION ❑ SITE INSPECTION REQUIRED 0 FOOTING c- `rY1 \\ 1 ❑ FOOTING DRAINAGE � - ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING 0 ROUGH FRAMING ❑ INSULATION 0 NATURAL GAS11 L.P. GAS r4 ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING Ei FINAL ❑ OTHER a a n ON � � N N ry o a M N G a say e ■ bo w � w a a fy W N � w � ■ ■ �y/ w 5 p ow o � c 3 r �" ■ �p w �o , Ucoa ■ n mu, a , P FJUN SDI BUIL E MENT VIL E OF RYE OK 6 2015 938 KrNd ET RYE B ,NY 10573 (914)9 ' } 939-5801 VILLAGE OF RYE BROOK r' Org BUILDING DEPARTMENT PLUMBING PERMIT APPLICATION *MUST BE FILED BYA LICENSED AMSTER PLUMBER ONLY* I 1 Date: Plumbing Permit# � 1�`n"� Permit#: '! (�_ I D J Fee: — Approval Signature: (fees are non-refun able) Application is hereby made to the Building Inspector of the Village of Rye Brook NY,for the issuance of a Permit to install Plumbing as per detailed statement described below,and in accordance with all applicable Federal, State, County and Local Codes,at the following location: Address: ICJ , rr� L� ._te�tc hl`C Phone#: 314`1-a(3 - SS Owner: Address& Phone:kS3�-�1�1-0116�1- UselOccupancy: Parcel I.D.#: Zone: LICENSED MASTER PLUMBER'S INFORMATION: Name(please print): l/ Phone#:T� ?07 - .2 Signature: Westchester County License#: S-Z5 Company acne: X/4 Company Address:*<119 /'9—A I o U, CAlYr" City/Town: .t ee4LJ!7re T State: /1 Zip Code: /aSn Phone#: 7/4- ?O%' FIXTURES&LINES ARE TO BE INSTALLED ACCORDING TO THE FOLLOWING SCHEDULE: Location Water Urinals Drinking Sinks Showers Bath Laundry Domestic Fire Sanitary Natural/ Other* "Total Closets Fountains Tubs Tubs Service Service Sewer LP Gas Basement Ist Floor 2nd Floor Outside *Other: Detailed Description of Appliances etc...:'5��,4�\\ a-I 010 AG- "acce� �LS can A 4��CO><t1�iT# �� Van�0RK: F C I . NAME FJUN6 2015 Q�� VILLAGE OF RYE BROOK STREET BUILDING DEPARTMENT TOWN °tom 1 •�0 V� PIPE: BLACK IRON PILA STIC COPPER n/ SIZE LENGTH 'TANK SffZZ E (t COLOR TOOLS: i LADDER : YES-------NO W YES WHAT SIZE HAMMER DRILL YES------NO PIPE THREADER YES------NO RECIPROCATI1",IG SAW YES----I,IO CIRCULAR SAKI YES-----NO OTHER HOUSE: MASONRY----STONE---BRICK---VIINYL---ALUMb1 U1 A---`HOOD---O'I'H ER Tank SupplyingTank Foundati6n Tank Delivered Date II Tank Location /Delivery Distance Job Trench Date (- A Job Installation Date Map: L�.� 0 c' I ........... -MV I ra. LO RM co CD 4-4 ".4 --T- °l al ZR' —F, uj 4- try I cn Q) Q) LLJ P. Z W Lf) 0 C) _j uj V (1) - a w E J, uj Fn� 5 CL z LLJ Ln CO 4-o 03 —IM w FZ ;> 0 < co U uj U 1psi. 73 r 71 LO 0 co 4-) co cn aj 0- . .. E� �% CMNrNWZ,, � PHMO"V i Aw ,,7WN SR" I ^Mf- IMI, I0 , N % ffl a , AcoRo CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYW) Ill 5/6/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements). PRODUCER CONTACT NAME: Carol DeLuca Capacity Group of New York rue E -2 -7 AIC No: -2 1983 Marcus Avenue, Suite 140 E-MAIL Lake Success NY 11042 ADDRESS: I c it n .corn INSURERS AFFORDING COVERAGE NAIC# INSURER A:H DI-Gerling DI-ling America Insurance Co. 41343 INSURED 345 INSURER B: Halstead-Quinn Petroleum Co., Inc. INSURERC: 33 Hubbells Drive INSURER D: Mt. Kisco NY 10549 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER:1270810367 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TypE OF INSURANCE AD L UBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER MMIDDIYYYY MMIDDIYYYY A GENERAL LIABILITY Y Y EGGCD000051114 /112014 /112015 EACH OCCURRENCE $2,000,000 X DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $100,000 CLAIMS-MADE [XI OCCUR MED EXP(Any one person) $excluded PERSONAL&ADV INJURY s2,000,000 GENERAL AGGREGATE $2,000.000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $2,000,000 POLICY X PRO- LOC F LIMIT $ A AUTOMOBILE LIABILITY Y EAGCD000051114 H1201d H12015 Eaaccdent $2,000,000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS $ NON-OWNED PPROPPERd@ DAMAGE X HIREDAUTOS 1xx AUTOS X MCS-90 CA0112 $ A X UMBRELLA LIAR X OCCUR EXAGD000051114 /112014 H12015 EACH OCCURRENCE $3,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $3.000,000 DIED RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- LIMITS I I FIR AND EMPLOYERS'LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE NIA E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE s f yes.describe under DESCRI PTtON OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Subject to policy terms and conditions Village of Rye Brook is included as Additional Insured with regard to work performed by the Named Insured on their behalf. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Village of Rye Brook Building Dept. ACCORDANCE WITH THE POLICY PROVISIONS. 938 King Street Rye Brook NY 10573 AUTHORIZED REPRESENTATIVE O 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD New York State Insurance Fund Workers'Compensation&Disability Benefits Specialists Since 1914 105 CORPORATE PARK DRIVE SUITE 200,WHITE PLAINS,NEW YORK 10604-3814 Phone:(914)253-4661 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE A A A A A A 510423602 HALSTEAD-QUINN PETROLEUM CO, INC. DBA HALSTEAD-QUINN PROPANE CO 33 HUBBELLS DRIVE MOUNT KISCO NY 10549 POLICYHOLDER CERTIFICATE HOLDER HALSTEAD-QUINN PETROLEUM CO, INC. VILLAGE OF RYE BROOK DBA HALSTEAD-QUINN PROPANE CO 938 KING STREET 33 HUBBELLS DRIVE RYE BROOK NY 10573 MOUNT KISCO NY 10549 POLICY NUMBER CERTIFICATE NUMBER PERIOD COVERED BY THIS CERTIFICATE DATE W2192 053-3 764597 02101/2015 TO 02/01/2016 5/6/2015 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO.2192 053-3 UNTIL 02/01/2016, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER`S REGULAR NEW YORK STATE EMPLOYEES ONLY, IF SAID POLICY IS CANCELLED,OR CHANGED PRIOR TO 02/01/2016 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, 10 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE. NOTICE BY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THE NEW YORK STATE INSURANCE FUND DOES NOT ASSUME ANY LIABILITY IN THE EVENT OF FAILURE TO GIVE SUCH NOTICE. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. NEW YORK STATE INSURANCE FUND C� DIRECTOR,INSURANCE FUND UNDERWRITING This certificate can be validated on our web site at https.liwww.nysif.com/cert/certval.asp or by calling (888)875-5790 VALIDATION NUMBER: 274610941 U-26.3